Breeze Underwriting Application Form Accountants Professional Indemnity Insurance
|
|
- Griffin James
- 8 years ago
- Views:
Transcription
1 Application Form Accountants Professional Indemnity Insurance Send quotation requests to: Phone: IMPORTANT NOTICES Please read these Important tices before applying for this insurance. The Cover Professional Indemnity insurance is issued on a claims made basis. This means that the policy covers you for claims made against you and notified to the insurer during the period of insurance provided that you were not aware at any time prior to the start of the inception date of the cover, of circumstances that would have put a reasonable person in your position on notice that a claim may be made against you. Usually no new claim notification can be made after the period of insurance has ended even though the event giving rise to the claim may have occurred during the period of insurance. tification requirements are subject of Section 40 of the Insurance Contract Act 1984 Your policy will not insure you for any claims arising out of circumstances you were aware of at any time prior to the inception of the period of insurance. Information This application must be fully completed and you must report full details of all circumstances which have become known to you or that a claim arising from an event may be made against you. See your Duty of Disclosure below. If there is insufficient space on the application please use a separate signed and dated headed sheet of paper. Where available, brochures, standard contract conditions, agreements, letters of appointment should be provided. Duty of Disclosure Under the Insurance Contracts act 1984 (the Act), you have a duty of disclosure. You are required before you enter into, renew, vary extend or reinstate your Policy, to tell us everything you know and that a reasonable person in the circumstances could be expected to know, is a matter that is relevant to our decision whether to insure you, and anyone else to be insured under the Policy, and if so, on what terms. You don t need to tell us about any matter: that reduces the risk, is of common knowledge, that we already know, or ought to know in the ordinary course of our business as an insurer, or we indicate we do not want to know. If you do not tell us If you do not comply with your Duty of Disclosure we may: reduce or refuse to pay a claim, or cancel your Policy. If your non-disclosure is fraudulent, we may also have the option of avoiding the Policy from its beginning. A business unit of Professional Services Corporation Pty Ltd ABN AFS Licence Page 1 of 8
2 Occurrence or Event tification During the period of insurance, if you become aware of any occurrence or event that may give rise to a claim and you during that period of insurance you have given written notice to the insurer of such occurrence or event, any claim made subsequent to that notification shall be deemed to be a claim made during the period of insurance. Right of Recovery Where another person or entity would be liable to compensate you for any loss or damage covered by this insurance but you have agreed with that person or entity at any time that you would not seek to recover that loss or damage, this insurance policy will not provide cover for such loss or damage. Business Alteration You must notify us within 7 days of any material alteration to the business that is the subject of this insurance. Material alterations are (but not limited to); the nature of the business; acquisition or merger with another business; an insured person or entity being declared bankrupt or entering receivership; cancellation or suspension of statutory registration or professional association membership. Privacy Privacy legislation regulates the way private sector organisations can collect, use, keep secure and disclose personal information. has developed a privacy policy which explains what sort of personal information we hold about you and what we do with it. You can obtain a copy of the Breeze Underwriting Privacy information brochure by contacting us at or from our website 1. Broker Details Broker name: Address: Contact Name: Phone: A business unit of Professional Services Corporation Pty Ltd ABN AFS Licence Page 2 of 8
3 2. Client Details Name Trading Name Address City State Postcode Period of Insurance A.B.N. Website From: 3. Description of Business Phone To: 4. Current Insurance Details Current Insurer Current Broker 5. Year Business Established 6. Additional Business Entities List all entities whether or not currently trading. Entity Year Established Year of Cessation Do you require cover in respect of all past activities of the entities listed in? A business unit of Professional Services Corporation Pty Ltd ABN AFS Licence Page 3 of 8
4 (c) List addresses of all other offices currently trading. Address Postcode 7. Business Details Detail the percentage split of work in the following disciplines where you have undertaken or been responsible for design or technical services: Discipline % Audit Accounting/Book-keeping Liquidation/Receivership Investment Advice Financial Planning Superannuation and Trust Funds Funds Management Taxation/GST Management Accounting Company Directorships Insurance Other (please specify in (c) below) Total 100% (c) Other Activities Mergers and Acquisitions % Forensic Accounting Other (please provide details) A business unit of Professional Services Corporation Pty Ltd ABN AFS Licence Page 4 of 8
5 (d) Detail the approximate percentage of your work in the following areas: Area of Work % n-profit and private companies Public companies in top 100 ASX Public companies - others Financial Institutions Other (please specify) Total 100% (e) Is the applicant aware of any change in business activity/structure that will occur in the coming year? (f) Have any of the entities in this application ever been insured for professional indemnity. Insurer Name Expiry date Premium $ Excess $ Limit of Indemnity $ (g) In respect of your Professional Indemnity, has any insurer declined an application, denied top pay a claim, refused renewal, imposed special conditions or cancelled a policy? (h) What is the amount of indemnity now required? $ A business unit of Professional Services Corporation Pty Ltd ABN AFS Licence Page 5 of 8
6 8. Staff and Partners Details of all principals, partners and/or directors Name Age Relevant Qualifications # Date Qualified # Attach a CV where applicant has less been established less than 3 years or where the individual has no formal qualifications. Numbers of employees in current business: Qualified Administrative Self Employed Consultants Other Total 9. Activities Total fee income for the last financial year and estimate for current year and forthcoming year: Year Ending Australia $ Elsewhere (in Aus $) Total / / / / / / Detail percentage breakdown of earnings specified in by State or Territory: NSW VIC QLD SA NT WA ACT TAS Total 100% A business unit of Professional Services Corporation Pty Ltd ABN AFS Licence Page 6 of 8
7 (c) Are you aware of any change in activity or structure that may occur in the coming financial year? 10. Claims Information Detail any professional indemnity claims and/or circumstances made against the entities and/or predecessors of the entities and/or your current and/or retired partners, directors or principal, either individually or otherwise for any negligence, errors, omissions, breach of professional duty or the like, whether successful or not: Date of Claim Claimant Name Details of Claim inc. any payments After full enquiry, are any of the partners, directors or principal aware of any pending claim and/or circumstances which may give rise to a professional indemnity claim against the applicant entity and/or predecessors of the entities and/or current and/or retired partners, directors or principals? Date of Circumstance Claimant Details A business unit of Professional Services Corporation Pty Ltd ABN AFS Licence Page 7 of 8
8 Have present or previous insurers been notified of and accepted all claims, notifications and circumstances? If, please provide details: 11. Signature and Declaration By completing and signing this application form, you declare that: 1. the disclosed information in this application is true an accurate in every respect and no information has been withheld which is likely to affect our decision about accepting this insurance; 2. If there is more than one insured and all have not signed this application, you have signed for and on their behalf; 3. you acknowledge we reserve the right to decline any application; 4. you acknowledge that if the applicant acquires, merges with or absorbs another practice or entity during the period of insurance, the insurer will require full details and may charge an additional premium; 5. you acknowledge that a signature on this application form does not provide insurance cover until the application is accepted in writing by the insurer. Signature (Principal, Partner or Director) Date Applicant s Title A business unit of Professional Services Corporation Pty Ltd ABN AFS Licence Page 8 of 8
Engineers, Architects, Surveyors and Relation Professions
Application Form Professional Indemnity Insurance Send quotation requests to: Email: distribution@breezeuw.com.au Phone: 1300 556 826 Engineers, Architects, Surveyors and Relation Professions IMPORTANT
More information4. DETAILS OF THE PRINCIPAL(S) OF THE FIRM How Long Practicing as Partner/Director
SURA Professional Risks Level 13 / 141 Walker St North Sydney NSW 2060 P O BOX 1813 North Sydney NSW 2059 Telephone. 02 9930 9500 Facsimile. 02 9930 9501 sura.com.au ACCOUNTANTS PROFESSIONAL INDEMNITY
More informationProfessional Indemnity Proposal Form. for. Accountants. Address: 5/3352 Pacific Highway Postal: PO Box 976. Springwood QLD 4127 Springwood QLD 4127
Professional Indemnity Proposal Form for Accountants Address: 5/3352 Pacific Highway Postal: PO Box 976 Springwood QLD 4127 Springwood QLD 4127 Phone: 07 3387 2800 Fax: 07 3208 2200 Email: pidirect@pidirect.com.au
More informationIMPORTANT NOTICE PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM
IMPORTANT NOTICE PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM Your Professional Indemnity Insurance Policy is issued on a CLAIMS MADE basis. This means that this policy
More informationHow To Get Insurance On A Company Policy In Australia
Proposal Form: Directors and Officers Insurance Important Notice Relating to this Proposal PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM. Your Directors & Officers Insurance
More informationProposal Form Information Technology Liability Insurance
Proposal Form Information Technology Liability Insurance Important Notice Relating to this Proposal PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM. Your Information Technology
More informationAUCTIONEERS & VALUERS ASSOCIATION OF AUSTRALIA
Professional Indemnity Insurance Proposal Form AUCTIONEERS & VALUERS ASSOCIATION OF AUSTRALIA IMPORTANT NOTICE Your Duty of Disclosure Before you enter into a contact of general insurance with any insurer,
More informationProfessional Indemnity Insurance Application Form Marsh Accountants Insurance Program
Professional Indemnity Insurance Application Form Marsh Accountants Insurance Program Phone: 1300 093 634 Email: accountants@marsh.com tice to the Applicant This notice must be read before you complete
More informationProfessional Indemnity Proposal Form
Professional Indemnity Proposal Form BuildSafe Insurance Brokers Pty Ltd ABN 84 109 623 976 AFSL 279367 5 Peninsula Boulevard, Seaford, Vic. 3198 Postal: P. O. Box 2294 Seaford, Vic. 3198 Phone: 1300 763
More informationProfessional Indemnity Proposal Form Agricultural Consultants
Rivers Insurance Brokers Pty Ltd (t) 07 3028 9494 PO Box 518, Annerley Qld 4103 (f) 07 3891 3111 23 Balaclava Street, Woolloongabba Qld 4102 ABN 28 010 242 681 AFS Lic. 247093 admin@riversinsurance.com.au
More informationProposal Form Australian Institute of Horticulture Professional Indemnity Insurance
Proposal Form Australian Institute of Horticulture Professional Indemnity Insurance Important Notice Relating to this Proposal PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL
More informationIMPORTANT NOTICES: Your duty, however, does not require disclosure of matter:
IMPORTANT NOTICES: CLAIMS MADE POLICY This Proposal is for a policy issued by ProRisk on a claims made and notified basis. This means that the policy only covers claims first made against you during the
More information1. NAME OF FIRM TO BE INSURED 2. ADDRESS OF FIRM 3. THE FIRM. (please include full names of all entities to be insured) Phone ( ) Email
SURA Professional Risks Level 13 / 141 Walker St North Sydney NSW 2060 P O BOX 1813 North Sydney NSW 2059 Telephone. 02 9930 9500 Facsimile. 02 9930 9501 sura.com.au MISCELLANEOUS PROFESSIONAL INDEMNITY
More informationProfessional Indemnity Insurance Proposal Form
Professional Indemnity Insurance Proposal Form Important Notices Claims Made Insurance This is a proposal for a Claims Made policy of insurance. This means that the policy covers you for any claims made
More informationIMPORTANT NOTES ABOUT PROFESSIONAL INDEMNITY INSURANCE
Page 1 of 6 IMPORTANT NOTES ABOUT PROFESSIONAL INDEMNITY INSURANCE Professional Indemnity insurance is different from most other types of insurance. The policy is issued on a "claims made" basis and a
More informationCombined Professional Indemnity and Public Liability Insurance Proposal Form
Combined Professional Indemnity and Public Liability Insurance Proposal Form Australian Institute of Landscape Designers and Managers Ltd and Australian Institute of Horticulture Inc Important Notice Relating
More informationACCOUNTANTS, BOOKKEEPERS & RELATED PROFESSIONS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM
ACCOUNTANTS, BOOKKEEPERS & RELATED PROFESSIONS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT FACTS RELATING TO THIS PROPOSAL FORM The Purpose of this Proposal Form is to set out all relevant
More informationProposal Form: Management Liability Insurance
Important Notice Relating to this Proposal PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM. Your Management Liability Insurance Policy is issued on a CLAIMS MADE basis.
More informationClaims Made Policy (applies to Professional Indemnity only) Your Duty of Disclosure. Excess. Your Legal Liability. Waiver of Rights.
Proposal Form Professional Indemnity & Public Liability Insurance for Swimming Pool Inspectors Arranged through ASR Underwriting Agencies Pty Ltd Underwritten by Certain Underwriters at Lloyd s IMPORTANT
More informationProfessional Indemnity Insurance Proposal Form Miscellaneous
Commercial & General Insurance Brokers (Aust) Pty Ltd Suite 4, 1016 Doncaster Road Doncaster East Victoria 3109 Phone: 1300 764 244 Fax: 03 8841 4299 Email: pi@cgib.com.au Web: www.cgib.com.au AFS License:
More informationInstitute of Mercantile Agents Combined Professional Indemnity and Public Liability Insurance Proposal Form
Institute of Mercantile Agents Combined Professional Indemnity and Public Liability Insurance Proposal Form Important Notice Relating to this Proposal PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING
More informationProfessional Indemnity Proposal Form. for. Financial Planners
Professional Indemnity Proposal Form for Financial Planners Address: 5/3352 Pacific Highway Postal: PO Box 976 Springwood QLD 4127 Springwood QLD 4127 Phone: 07 3387 2800 Fax: 07 3208 2200 Email: pidirect@pidirect.com.au
More informationDirectors & Officers Liability and Corporate Reimbursement Insurance Proposal Form
Directors & Officers Liability and Corporate Reimbursement Insurance Proposal Form Answer all questions. Blanks and/or dashes, or answers known to underwriters/brokers or N/A are not acceptable and will
More informationProfessional Indemnity MISCELLANEOUS PROPOSAL
Professional Indemnity MISCELLANEOUS PROPOSAL Please complete, sign and return with all attachments to: Name Position Address Email Phone If you have any questions regarding this form, please do not hesitate
More informationPROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT TICES - `CLAIMS MADE CONTRACTS OF INSURANCE Please read the following carefully before completing this proposal form: Your professional indemnity
More information4. DETAILS OF THE PRINCIPAL(S) OF THE FIRM How Long Practicing as Partner/Director
SURA Professional Risks Level 13 / 141 Walker St North Sydney NSW 2060 P O BOX 1813 North Sydney NSW 2059 Telephone. 02 9930 9500 Facsimile. 02 9930 9501 sura.com.au FINANCIAL PLANNERS PROFESSIONAL INDEMNITY
More informationProfessional Indemnity Insurance for the Planning Profession
Professional Indemnity Insurance for the Planning Profession Important Notices Claims Made Policy This Proposal is for a policy issued by the insurer on a claims made and notified basis. This means that
More informationWill you be claiming any Input Tax Credits on the GST applicable to this policy? Yes No If Yes, what percentage? % Suburb State Postcode
Accountants Professional Indemnity Insurance. Proposal Form Please complete and return this proposal form to Aon Risk Services Australia Ltd, GPO Box 1230, Melbourne VIC 3001 If you have any questions,
More informationBUSINESS, EXECUTIVE, LIFE COACHES PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM
BUSINESS, EXECUTIVE, LIFE COACHES PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT FACTS RELATING TO THIS PROPOSAL FORM The Purpose of this Proposal Form is to set out all relevant information
More informationMiscellaneous Professional Indemnity Insurance
Miscellaneous Professional Indemnity Insurance Proposal Form 1. All questions must be answered giving full and complete answers. 2. Please ensure that this Proposal Form is Signed and Dated. 3. All fee
More informationProfessional Indemnity Proposal Form
Professional Indemnity Proposal Form IMPORTANT NOTES This insurance cover is based upon representations given to us by you. Should any particulars have changed or be incorrect you must notify us immediately.
More informationPROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT FACTS RELATING TO THIS PROPOSAL FORM The Purpose of this Proposal Form is to set out all relevant information for your adviser to submit on your
More informationProfessional Indemnity Insurance
QBE Insurance (Australia) Limited ABN 78 003 191 035 Professional Indemnity Insurance Application Form Pool Safety Inspectors Notice to the Applicant This notice must be read before you complete the Application
More informationProfessional Indemnity Proposal
Professional Indemnity Proposal IMPORTANT NOTICES Your Duty Of Disclosure This Policy is subject to the Insurance Contracts Act 1984. Under that Act you have a duty of disclosure. Before you take out insurance
More informationProposal Form. Management Consultants Professional Liability Insurance
Management Consultants Professional Liability Insurance BusinessGuard AIG Australia Limited (AIG), ABN 93 004 727 753 AFSL 381686, Level 12, 717 Bourke Street, Docklands VIC 3008 Important Notice Claims-Made
More informationInvestment Structures Insurance Solutions (ISIS)
Investment Structures Insurance Solutions (ISIS) Directors and Officers Liability Entities Securities Professional Liability Crime Proposal form Instructions to applicant Completing the Proposal Form Please
More informationAccountants Professional Indemnity Insurance
Accountants Professional Indemnity Insurance Proposal Form 1. All questions must be answered giving full and complete answers. 2. Please ensure that this Proposal Form is Signed and Dated. 3. All fee or
More informationProfessional Indemnity Proposal Form. for. Information Technology Consultants
Professional Indemnity Proposal Form for Information Technology Consultants Address: 5/3352 Pacific Highway Postal: PO Box 976 Springwood QLD 4127 Springwood QLD 4127 Phone: 07 3387 2800 Fax: 07 3208 2200
More informationJUA Underwriting Agency Pty Ltd
JUA Underwriting Agency Pty Ltd Valuers Professional Indemnity Proposal Form Please answer every question fully, incomplete answers will not be accepted, and may result in a delay in terms being issued
More informationLiability Package for Associations and Non-profit Organisations
Liability Package for Associations and n-profit Organisations Answer all questions. Blanks or dashes, or answers known to underwriters or brokers or N/A are unacceptable & will delay consideration of this
More informationLiability Insurance Proposal
Liability Insurance Proposal For Information Technology Entities Woodina Underwriting Agency Pty Ltd AFS Licence No. 418755 NOTICE TO INSURED (Pursuant to the provisions of the Insurance Contracts Act
More informationHow To Get Insurance For A Car
Veterinarians Professional indemnity insurance (including optional public and products liability insurance and employment practices liability insurance) Proposal form 2011-2012 Please return completed
More informationProfessional indemnity insurance and optional public liability insurance
Agricultural Consultants Professional indemnity insurance and optional public liability insurance Proposal form 2011-2012 Please return completed proposal form to: Aon Risk Services Australia Limited ABN
More informationSOLICITORS EXCESS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL
SOLICITORS EXCESS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL A. Your Duty of Disclosure Before you enter into a contract
More informationProfessional Indemnity Insurance AILA Proposal
Professional Indemnity Insurance AILA Proposal September 2013 Please return this completed proposal to: Lynn Wainstein Lauren Malkin Tel (03) 9613 1442 Tel (03) 9613 1423 Email Lynn.Wainstein@jlta.com.au
More informationACCOUNTANTS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT FACTS RELATING TO THIS PROPOSAL FORM
Australian Indemnity ACCOUNTANTS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT FACTS RELATING TO THIS PROPOSAL FORM The Purpose of this Proposal Form is to set out all relevant information for
More informationProfessional Indemnity Insurance and optional Public & Products Liability
Advantedge Members (Incorporating PLAN, FAST and CHOICE Members) Professional Indemnity Insurance and optional Public & Products Liability Proposal form 2014-2015 Please return completed proposal form
More informationJUA Underwriting Agency Pty Ltd
JUA Underwriting Agency Pty Ltd Engineers & Architects Professional Indemnity Proposal Form Please answer every question fully, incomplete answers will not be accepted, and may result in a delay in terms
More informationMEDICAL ESTABLISHMENTS MEDICAL MALPRACTICE INSURANCE PROPOSAL FORM
MEDICAL ESTABLISHMENTS MEDICAL MALPRACTICE INSURANCE PROPOSAL FORM IMPORTANT INFORMATION Please read the following information before completing this proposal A. Your Duty of Disclosure Before you enter
More informationProfessional Indemnity Insurance Proposal Form for Actuaries (short form)
Professional Indemnity Insurance Proposal Form for Actuaries (short form) Marsh Pty Ltd ABN 86 004 651 512 Darling Park Tower 3 201 Sussex Street SYDNEY NSW 2000 PO Box H176 AUSTRALIA SQUARE NSW 1215 Telephone
More informationPROFESSIONAL INDEMNITY INSURANCE PROPOSAL
NOTICE TO INSURED (Pursuant to the provisions of the Insurance Contracts Act 1984) Your Duty of Disclosure Before you enter into a contract of general insurance with an insurer, you have a duty, under
More informationProfessional Indemnity Proposal Form. for. Finance & Mortgage Brokers
Professional Indemnity Proposal Form for Finance & Mortgage Brokers Address: 5/3352 Pacific Highway Postal: PO Box 976 Springwood QLD 4127 Springwood QLD 4127 Phone: 07 3387 2800 Fax: 07 3208 2200 Email:
More informationMISCELLANEOUS CONSULTANTS PROFESSIONAL INDEMNITY PROPOSAL FORM
MISCELLANEOUS CONSULTANTS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL A. Your Duty of Disclosure Before you enter into
More informationREAL ESTATE AGENTS PROFESSIONAL INDEMNITY PROPOSAL FORM
REAL ESTATE AGENTS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION Please read the following information before completing this proposal A. Obtaining a Quotation To minimise delays in obtaining
More informationProfessional Indemnity API VALUERS PROPOSAL FORM
Professional Indemnity API VALUERS PROPOSAL FORM Please return this completed proposal to: Perrymans General Insurance Brokers PO Box 596, Kent Town SA 5071 Fax: 08 8362 3131 Email: api@perrymans.com If
More informationPROFESSIONAL INDEMNITY RENEWAL DECLARATION IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS RENEWAL DECLARATION
PROFESSIONAL INDEMNITY RENEWAL DECLARATION IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS RENEWAL DECLARATION A. Obtaining a Quotation To minimise delays in obtaining
More informationReal Estate Contractors ADDENDUM QUESTIONNAIRE. Please complete, sign and return with all attachments to: Name Position Address Email Phone
Real Estate Contractors ADDENDUM QUESTIONNAIRE Please complete, sign and return with all attachments to: Name Position Address Email Phone If you have any questions regarding this form, please do not hesitate
More informationSOLICITORS EXCESS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL
SOLICITORS EXCESS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL A. Your Duty of Disclosure Before you enter into an insurance
More informationProfessional Indemnity Insurance Proposal Form Management Consultants (with Recruitment / On-Hired Labour Addendum)
Professional Indemnity Insurance Proposal Form Management Consultants (with Recruitment / On-Hired Labour Addendum) IMPORTANT NOTICE Your Duty of Disclosure Before you enter into a contact of general insurance
More informationProposal Form. Architects Professional Indemnity
Proposal Form Architects Professional Indemnity Important Notices Please read these notices before completing the Proposal Form. Your Duty of Disclosure Before you enter into a contract of general insurance
More informationProfessional indemnity insurance
Pest controllers Professional indemnity insurance Proposal form 2011-2012 Please return completed proposal form to your nearest Aon office (back page of proposal) Aon Risk Services Australia Limited ABN
More informationProfessional Indemnity Insurance Proposal Form for the Horticulture Industry
Professional Indemnity Insurance Proposal Form for the Horticulture Industry Important Notices Claims Made Insurance This is a proposal for a Claims Made policy of insurance. This means that the policy
More informationProfessional Indemnity Insurance. Proposal Form for Property Consultants
Professional Indemnity Insurance Proposal Form for Property Consultants Important Notices PLEASE READ THE FOLLOWING NOTICES BEFORE COMPLETING THIS PROPOSAL FORM. Your Duty of Disclosure Contracts of General
More informationConsultants Insurance Application
Consultants Insurance Application Notice to the proposed insured: It is a requirement of the insurance Contracts Act 1984 and the Corporations Act 2001 that the following notices 1., 2., 3., 4., 5. and
More informationProposal Form. BusinessGuard Accountants Professional Liability Insurance
BusinessGuard Accountants Professional Liability Insurance Important Notice Claims-Made and Notified Insurance This policy is issued by AIG Australia Limited on a claims-made and notified basis. This means
More informationFinancial Institutions Directors and Officers Liability Insurance Proposal Form
Financial Institutions Directors and Officers Liability Insurance Proposal Form The following documents must be submitted with this proposal form: ( ( ( (d) (e) The annual report and financial statements
More informationEXCESS SOLICITORS PROPOSAL FORM
EXCESS SOLICITORS PROPOSAL FORM PROFESSIONAL INDEMNITY London Australia Underwriting Pty Ltd Level 35, 100 Miller Street rth Sydney Australia 2060 t 02 8912 6400 f 02 8912 6401 www.lauw.com.au IMPORTANT
More informationProfessional indemnity insurance
Professional indemnity insurance 2014 mini policy for CPA Australia members What is CPA Australia s mini policy? Fenton Green & Co. has arranged a professional indemnity insurance (Pll) mini policy (mini
More informationLABOUR FORCE PROFESSIONAL LIABILITY INSURANCE PROPOSAL FORM
SURA LABOUR HIRE PTY LTD SUITE 1.04 29 31 LEXINGTON DRIVE BELLA VISTA NSW 2153 TELEPHONE. 02 9672 6088 SURA.COM.AU LABOUR FORCE PROFESSIONAL LIABILITY INSURANCE PROPOSAL FORM IMPORTANT NOTICES The information
More informationProfessional Indemnity Insurance Proposal Form Lawyers Excess of Loss / Top-Up Insurance
Professional Indemnity Insurance Proposal Form Lawyers Excess of Loss / Top-Up Insurance IMPORTANT NOTICE Your Duty of Disclosure Before you enter into a contact of general insurance with any insurer,
More informationPROPOSAL FORM FOR INTERNATIONAL INVESTMENT MANAGERS PROFESSIONAL INDEMNITY INSURANCE
PROPOSAL FORM FOR INTERNATIONAL INVESTMENT MANAGERS PROFESSIONAL INDEMNITY INSURANCE Prime International (a trading name of Miller Insurance Services LLP) 70 Mark Lane, London EC3R 7NQ Tel: +44 20 7488
More informationlabour force professional liability insurance
labour force professional liability insurance application form Notices 1. Intermediary Acting as an Agent for Insurer In effecting this contract of insurance, Lawsons Underwriting Australasia Ltd ABN 35
More informationEngineers, Architects, Surveyors And Relation Professions Professional Indemnity Proposal Form
Engineers, Architects, Surveyors And Relation Professions Professional Indemnity Proposal Form Once completed, please sign and return together with any additional sheets and attachments to: Prime Underwriting
More informationProposal Form. BusinessGuard Insurance Brokers Professional Liability Insurance
BusinessGuard Insurance Brokers Professional Liability Insurance BusinessGuard Insurance Brokers Professional Liability Insurance This policy is issued by AIG Australia Limited on a claims-made and notified
More informationlabour force professional liability insurance
labour force professional liability insurance application form Notices 1. Intermediary Acting as an Agent for Insurer In effecting this contract of insurance, Lawsons Underwriting Australasia Ltd ABN 35
More informationSpecialists at minimising risk exposure. Professional Indemnity Insurance Insurance Proposal Form
Specialists at minimising risk exposure Professional Indemnity Insurance Insurance Proposal Form Professional Indemnity Insurance Application Office Use Only Core Customer Segment Account number Policy
More informationMedical Malpractice Insurance Proposal Form. for. Miscellaneous Medical Professionals
Medical Malpractice Insurance Proposal Form for Miscellaneous Medical Professionals Address: 5/3352 Pacific Highway Postal: PO Box 976 Springwood Qld 4127 Springwood Qld 4127 Phone 07 3387 2800 Fax 07
More informationREAL ESTATE AGENTS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL
REAL ESTATE AGENTS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL A. Your Duty of Disclosure Before you enter into a contract
More informationCommercial Builders Structural Defects Insurance Proposal (Victoria)
Commercial Builders Structural Defects Insurance Proposal (Victoria) NOTICE TO THE APPLICANT FOR INSURANCE IMPORTANT NOTICES Commercial Builders Structural Defects insurance policies issued by AXIS Specialty
More informationProfessional Indemnity Insurance Proposal.
ProJuris Professional Indemnity Professional Indemnity Insurance Proposal. Important information What is a proposal? This proposal tells us information, which we need to know in order to decide whether
More informationPROFESSIONAL INDEMNITY & LIABILITY INSURANCE POLICY
HEALTH PROFESSIONALS INSURANCE PROFESSIONAL INDEMNITY & LIABILITY INSURANCE POLICY for individual practitioners Healthcare Practice & Program Management Allied Health Practitioners Paramedicine Midwifery
More informationIMPORTANT NOTICE PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM
IMPORTANT NOTICE PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM Your Professional Indemnity Insurance Policy is issued on a CLAIMS MADE basis. This means that this policy
More informationProposal Form: Group Personal Accident Insurance
Important tice Relating to this Proposal PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM. Your Duty of Disclosure Before you enter into a contract of general insurance
More informationInsurance Brokers Professional Indemnity Proposal Form
Insurance Brokers Professional Indemnity Proposal Form Solution Underwriting Agency Pty Ltd Level 6, 289 Flinders Lane Melbourne, VIC 3000 ABN 68 139 214 323 AFSL 407780 1 of 12 Additional information
More informationPROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM Answer all questions. Blanks &/or dashes, or answers known to underwriters or brokers or N/A are not acceptable & will delay consideration of this proposal.
More informationREAL ESTATE AGENTS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL
REAL ESTATE AGENTS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL A. Your Duty of Disclosure Before you enter into an
More informationProfessional Indemnity Proposal form
Important Information Please read this first Professional Indemnity Proposal form Important facts relating to this proposal form You should read the following advice before proceeding to complete this
More informationProfessional Indemnity Insurance Proposal Form for Engineers and Construction Professionals
Professional Indemnity Insurance Proposal Form for Engineers and Construction Professionals Answer all questions. Blanks &/or dashes, or answers known to underwriters or brokers or N/A are not acceptable
More informationProfessional Indemnity Insurance BDA Proposal
Professional Indemnity Insurance BDA Proposal September 2012 Please return this completed proposal to: Kathleen Sutherland Unit 10, Building I1, 22 Powers Road Seven Hills NSW 2147 Tel 02 8824 1600 Fax
More informationHow To Write A Proposal Form For Insurance (Uk) Ltd
PROPOSAL FORM FOR IT CONSULTANTS PROFESSIONAL INDEMNITY INSURANCE Precision Underwriting (UK) Limited, 3 rd Floor, 14 Cullum Street, London, EC3M 7JJ. T: +44 (0) 20 7398 0800 F: +44 (0) 20 7398 0801 E:
More informationPublic Relations / Marketing Consultants. Professional Indemnity Insurance
Public Relations / Marketing Consultants Public Relations Consultants Marketing Consultants Market Research Consultants Advertising Consultants Graphic Designers Professional Indemnity Insurance Proposal
More informationProposal Form. BusinessGuard Mortgage/Finance Brokers, Originators, Managers Professional Liability Insurance
BusinessGuard Mortgage/Finance Brokers, Originators, Managers Professional Liability Insurance BusinessGuard Mortgage/Finance Brokers, Originators, Managers Professional Liability Insurance Important Notice
More informationProfessional Indemnity Insurance AIAST Proposal
Professional Indemnity Insurance AIAST Proposal February 2013 Please return this completed proposal to: Bill Hogg or Lynn Wainstein Jardine Lloyd Thompson Pty Ltd Level 17, 607 Bourke Street, Melbourne
More informationMEDICAL ESTABLISHMENTS MEDICAL MALPRACTICE INSURANCE PROPOSAL FORM
MEDICAL ESTABLISHMENTS MEDICAL MALPRACTICE INSURANCE PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL A. Your Duty of Disclosure Before you enter
More informationAccounting professionals
Professional Indemnity Insurance Proposal Form Accountant/Bookkeepers/Tax Agents Commercial & General Insurance Brokers (Aust) Pty Ltd Suite 4, 1016 Doncaster Road Doncaster East Victoria 3109 Phone: 1300
More informationAccountants Professional Liability Insurance Proposal Form
Accountants Professional Liability Insurance Proposal Form AIG Australia Proposal Form American Home Assurance Company AB 67 007 483 267 AFSL o 230903 incorporated with limited liability in the USA, trading
More information4. DETAILS OF THE PRINCIPAL(S) OF THE FIRM How Long Practicing as Partner/Director
SURA Professional Risks Level 13 / 141 Walker St North Sydney NSW 2060 P O BOX 1813 North Sydney NSW 2059 Telephone. 02 9930 9500 Facsimile. 02 9930 9501 sura.com.au architects PROFESSIONAL INDEMNITY insurance
More informationProposal Form. BusinessGuard Specified Professions Professional Liability Insurance
BusinessGuard Specified Professions Professional Liability Insurance An Important Notice Claims-Made and Notified Insurance This policy is issued by AIG Australia Limited (AIG), ABN 93 004 727 753 AFSL
More informationManagement Liability Insurance proposal form
IMPORTANT INFORMATION Please read this first Management Liability Insurance proposal form You should read the following advice before proceeding to complete this Proposal Form. 1. Duty of disclosure Before
More informationProposal Form. BusinessGuard Financial Planners Professional Liability Insurance
BusinessGuard Financial Planners Professional Liability Insurance AIG Australia Limited (AIG) ABN 93 004 727 753 AFSL No 381686 Sydney: Head Office: Level 19, 2 Park Street, NSW 2000 (1300 030 886) Melbourne:
More information